Hypoglycaemia (often called a HYPO)
What is hypo
Hypoglycaemia is the medical term for low blood sugar. If your blood sugar level falls
below 4 you are at risk of having a "hypo". Some people may feel as if they are having a
"hypo" when their sugars are higher than 4. This may be because their body is used to
having higher sugars than the normal range of 4 to 7.
What does a hypo feel like?
The symptoms of a hypo vary from person to person.
The earliest feelings may be hunger, shakiness, anxiousness and starting to sweat. You
may have palpitations, tingling in the hands, a slight headache, feel dizzy or weak. You
may find it difficult to concentrate, feel moody or bad tempered. Often others recognises
these symptoms before you do.
If you don’t treat your early symptoms of hypo quickly, your brain will not have enough
sugar to work normally. As your blood sugar level falls further these symptoms become
more intense. Your coordination may suffer and vision may start to blur. Again, others
may notice you behaving strangely although you may not be aware of it at the time. Some
individuals with hypo become aggressive. Many of these symptoms mimic the effects of
alcohol and people around you may think you are drunk. Let your family and friends read
this so they will recognise this unusual behaviour and be able to help you. They should
not take any notice if you try to refuse their help – you may not recognise your symptoms
and be reluctant to take the sugar they offer.
After a hypo
You may feel emotional, headachy, or sick.
You may find that your sugars are higher than normal (sometimes over 20). Don’t worry
but continue to check your blood sugar and if you don’t go back to your normal blood
sugar readings then see your practice nurse or GP (Link to high blood sugars)
What can cause a hypo?
Diabetes does not cause hypo. There are various reasons why hypo's happen:
• eating too little
• missing or delaying a meal or snack
• exercising more than usual
• taking too much insulin, or lumpy injection sites
• taking too many tablets for diabetes
• drinking too much alcohol
• stress
• hot weather
What are the dangers of hypo?
Having an occasional hypo will do no harm. Repeated hypo’s resulting in coma may,
over time, result in a change in your mental ability. Having a hypo while driving,
swimming or working at heights has obvious implications
What is the treatment?
If you have any hypo symptoms you should do a blood glucose check. If your level is not
below 4 then it’s unlikely( but not impossible) to be a hypo. If in doubt, take some fast
acting sugar anyway.
Mild hypo (for instance tingling lips and/or blurred vision)
Treating a mild hypo is simple. Take 3 dextrose tablets or 2 lumps or 2 teaspoons of
sugar or a sweet drink.
When you start feeling better have a snack such as a glass of milk and a biscuit or a
sandwich, or eat your next meal early. Always carry some form of sugar with you.
Moderate hypo (for instance lack of concentration, blurred speech)
For a moderate hypo take some sugar (liquid form is the easiest) as soon as possible.
Explain to your family and friends that they may have to pour the liquid into your mouth
and encourage you to drink it – but only if you are still conscious. If you cannot or will
not swallow, Glucogel (a sugar gel available on prescription from your G/P) can be
placed in your mouth. This should be absorbed from the lining of the cheek rather than
swallowed. It is ideally placed between the jaw and the cheek. It should not be used if
you are unconscious.
Severe hypo (needing the assistance of a another person)
Occasionally you may not spot your warning signs and you may pass out and become
unconscious. Some people with diabetes do not get good warning signs. This is more
common in people who have either had diabetes for a long time or who have frequent
hypos. Explain to your family and friends that if they find you unconscious they will need
to:
• call 999 immediately for an ambulance
• inject you with GlucaGen if your doctor has provided you with this.
• not to give anything by mouth as this could cause you to choke.
What is Glucagon?
Glucagon is a hormone (like insulin) produced by the pancreas which has the opposite
effect of insulin and raises the blood sugar level. It is given as an injection and injected in
the same way as insulin and comes in a hypo kit called GlucaGen.
Within the GlucaGen Hypo Kit is found a bottle of powdered glucagon and a syringe
filled with water. The dose is prepared just before injection.
As GlucaGen can make the person sick, place the person on their side after injection.
Once they have come round is give them food such as a sandwich or biscuit and drink
and reassure them.
Are there any types of insulin more likely to cause hypos?
All preparations of insulin can cause hypo’s and people with diabetes respond differently
to different types and doses of insulin.
What if I have a hypo when my injection is due?
It is difficult to give precise advice about this situation as there may be a number of
reasons for the hypo that may need looking at. As a general rule; first treat the hypo to
make sure your blood sugar levels are restored to normal. Give your usual dose of insulin
and eat your usual meal. You may need your insulin dose reducing and you should
discuss this with your practice nurse at the first opportunity. Do not miss your dose of
insulin as this is likely to lead to a large 'swing' of your blood glucose levels.
Recurrent hypo’s
If you have recurring hypos, see your doctor or diabetes nurse. Recurring hypo’s can
sometimes be a difficult problem to solve. The cause may be one or more of the
following:
• skipping meals
• alcohol
• exercise
• too much insulin or lumpy injection sites.
• hypo unawareness (loss of warning symptoms)
Hypo’s and driving
If driving you should stop your vehicle as soon and as safely as possible.
Take a tablet of glucose or a glucose drink
Remove the ignition key and move to the passenger seat. If on the Motorway leave your
car with hazard warnings on and move to a position of safety.
Refer to the leaflet Diabetes and Driving for more advice on diabetes and driving
Night time hypo’s
Hypo's can occur at any time of the day, but are a particular worry to people with
diabetes ( and their families ) when they happen at night
Drinking alcohol in the evening, especially on an empty stomach and without a bed time
snack will add to the risk of a night time hypo.
Hypos at night may cause you to wake up sweating, feeling shaky with palpitations or
chills. Early morning headache and high blood sugar readings before breakfast may
occur.
The ideal way to find out if you are having night hypos is to measure your blood sugar
during the night. Set your alarm clock to wake between 2 and 4am to check your blood.
Your blood sugar levels at bed time are not a reliable guide to the risk of hypos during
the night. So if you usually have a bed time snack, don’t miss it out if your blood sugar
reading is high. (in fact never eat less food because your sugar readings are high )
The problem is usually solved by adjusting your insulin dose or type or taking a bed time
snack. You will need to see your Practice nurse or G/P to discuss this.